7th annual Envisioning Youth Empowerment (EYE) Retreat Participant Application
BASIC INFORMATION ABOUT THE EYE RETREAT:
Who:  Youth with visual impairments who want to learn about college and careers.
What:  An annual weeklong camp sponsored by The Governor Morehead School Alumni Association to improve post secondary outcomes.    
When:  Sunday, July 26th to Saturday, August 1st (Staff arrive Saturday, July 25th).
Where:  The Governor Morehead School, NC State University & area businesses.
Why:  To provide an opportunity for youth with visual impairments to experience a glimpse of post secondary outcomes (careers, college, etc) through development of mentoring relationships with other visually impaired individuals, real world applications of college and career skills, and identification of available resources in the community.

SAMPLE ACTIVITIES:  

1.  Time management
2.  Self-advocacy course
3.  Assistive technology
4.  Riding public transportation
5.  Sports and recreation
6.  Money management
7.  Career exploration
8.  Visiting college campuses
9.  Meeting and mentoring by employed persons with visual impairments.
10.  Meeting and mentoring by college students with visual impairments

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Name (first and last) *
Address (street, city, state, and zip code) *
Which track are you most interested in attending? *
Our college track includes a mock college course.  Our careers track include job shadowing opportunities.
How old are you? *
What is your home phone number? *
What is your cell phone number? *
What is your email address? *
Currently, I am: *
I consider myself to be: *
My t-shirt size is: *
My gender is: *
Do you have any medical conditions besides blindness (be specific)? *
Do you take any medications and do you require assistance taking them (be specific)? *
Do you have any food allergies or restrictions (be specific)? *
Do you require any other accommodations in order to participate (be specific)? *
How do you access printed materials? *
In one sentence, tell us why you wish to attend the EYE Retreat? *
Are you interested in having a mentor throughout the year after the week of the EYE Retreat has ended? *
Are you interested in participating in other EYE Retreat activities throughout the year, such as Saturday Seminars, Goal Ball, or other planned activities? *
Please provide contact information for a family member or friend in the event of an emergency. *
Name, phone number(s), and relationship to you.
Is all the information you have provided on this form true and accurate? *
Print YOUR name here indicating you are submitting this application with true and accurate information.   *
PARENTS/GUARDIANS:  If the participant is under the age of 18, Print YOUR name here indicating you are submitting this application with true and accurate information.  
All participants should submit a nonrefundable commitment fee of $30.00 when submitting their application. *
We strongly encourage you to pay this online when you apply.  Make checks payable to GMSAAI and mail to 1217 Manassas Court Unit C Raleigh, NC 27609.  Your commitment fee includes 17 meals, 6 nights of lodging, daily city bus passes, and a t-shirt.
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